Form 1095-B - Full Page Recipient


Preprinted Form 1095-B
Full page with preprinted instructions on back.

Use this preprinted laser form for printing form 1095-B. Folding perforation at 5 ½”. Order by number of sheets needed.

Compatible envelopes:
- 95DWENV05
- 95DWENVS05

A 1095-B form must be issued by a self-insured employer with less than 50 full-time employees (including full-time equivalent employees), or by the insurer to employees and to the IRS as proof of healthcare coverage.

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